GA EmpowerMEnt - Adult Application

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1. Name:

Name:

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2. Phone Number:

Phone Number:

3. E-mail address:

E-mail address:

4. Home address:

Home address:

5. I prefer to be contacted by:

I prefer to be contacted by:   Phone E-mail

6. The best time of day to reach me is:

The best time of day to reach me is:   Morning Afternoon Evening

7. I am a foster youth alumni:

I am a foster youth alumni:   Yes No

8. Please describe any previous experiences working/volunteering with youth in the foster care system or the juvenile justice system:

Please describe any previous experiences working/volunteering with youth in the foster care system or the juvenile justice system:

9. Please describe your experience working/volunteering with youth in unique populations (i.e. LGBT youth, developmental disabilities, mental health, etcetera):

Please describe your experience working/volunteering with youth in unique populations (i.e. LGBT youth, developmental disabilities, mental health, etcetera):

10. Why do you wish to be a mentor or volunteer for Georgia EmpowerMEnt?

Why do you wish to be a mentor or volunteer for Georgia EmpowerMEnt?

11. What do you feel you could bring to Georgia EmpowerMEnt as a volunteer or mentor?

What do you feel you could bring to Georgia EmpowerMEnt as a volunteer or mentor?

12. Please answer one of the following two questions:
1. If you had to choose a kitchen utensil to best describe you, which would you choose and why?
2. If you had to choose a cereal to best describe you, which would you choose and why?

Please answer one of the following two questions: 1. If you had to choose a kitchen utensil to best describe you, which would you choose and why? 2. If you had to choose a cereal to best describe you, which would you choose and why?

13. How much time would you like to commit to volunteering with Georgia EmpowerMEnt?

How much time would you like to commit to volunteering with Georgia EmpowerMEnt?   As often as needed. Couple hours a week. Couple hours a month. Once a month. Only when you are short on volunteers or are in desperate need.

14. What roles are you interested in?

What roles are you interested in?   Helping as a community partner to support youth trying to grow EmpowerMEnt in my region. Designing/Developing information materials on GA EmpowerMEnt (brochures, posters for schools and DFCS offices, etc.) Designing/Developing and managing a GA EmpowerMEnt Website, social networking sites, and use of cutting-edge technology. Designing/Developing and managing a GA EmpowerMEnt newsletter to keep people in the loop. Contribute your talents as an artist or musician to GA EmpowerMEnt's efforts. Public Speaking/Presentations/Media opportunities - speak on important issues - Atlanta AND local to your community. Training - identify the training needs for GA EmpowerMEnt and help locate and coordinate trainings. Finding resources, "door openers," and partners in your community to support GA EmpoweMEnt/Resource Development and Community Partnerships. Helping GA EmpoweMEnt together with designing a structure and plan. Helping GA EmpowerMEnt with collecting and analyzing information that will measure our progress (Self-Evaluation). Extending Medicaid/health insurance for youth until 21. Teen moms and fathers remaining with their children while in care. More stable school/educational experiences. Networks of caring, consistent, permanent relationships for foster youth. Driver's license needs. Better relationships with caseworkers. Sibling/family visitation. Homelessness Youth involved with DJJ and DFCS. Youth who have disabilities. Youth for whom English is a second language. Youth who identify as LGBTQ. Making laws/court processes better for kids and families. Youth with mental health/behavior needs.

Others not mentioned above: